Towards a ANZ Hip Fracture Registry “Quality Care Costs Less”

Hip fractures due to falls Males and females, Australia Source: Bradley C Hospitalisations due to falls by older people, Australia 2006–07. Injury research and statistics series no. 56. Cat. no. INJCAT 132. Australian Institute of Health and Welfare, Canberra.

Fragility hip fracture rates by year, WA, Average yearly change: Indigenous, +6.9% (95%CI 2-12%) vs non-Indigenous, -3.6% (95%CI 3-4%)

Falls and fracture care and prevention A road map for a systematic approach Hip fracture patients Objective 1: Improve outcomes and improve efficiency of care after hip fractures Non-hip fragility fracture patients Objective 2: Respond to the first fracture, prevent the second – through Fracture Liaison Services in acute and primary care Individuals at high risk of 1 st fragility fracture or other injurious falls Objective 3: Early intervention to restore independence – through falls care pathway linking acute and urgent care services to secondary falls prevention Older people Objective 4: Prevent frailty, preserve bone health, reduce accidents – through preserving physical activity, healthy lifestyles and reducing environmental hazards Stepwise implementation - based on size of impact 1. DH Prevention Package for Older People

Falls and fracture care and prevention A road map for a systematic approach Hip fracture patients Objective 1: Improve outcomes and improve efficiency of care after hip fractures Non-hip fragility fracture patients Objective 2: Respond to the first fracture, prevent the second – through Fracture Liaison Services in acute and primary care Individuals at high risk of 1 st fragility fracture or other injurious falls Objective 3: Early intervention to restore independence – through falls care pathway linking acute and urgent care services to secondary falls prevention Older people Objective 4: Prevent frailty, preserve bone health, reduce accidents – through preserving physical activity, healthy lifestyles and reducing environmental hazards Stepwise implementation - based on size of impact 1. DH Prevention Package for Older People High volume, high cost Evidence around model/s of care Evidence of clinical variation in practice Evidence of sub-optimal care Evidence that data can be used to drive change

Inter-professional collaboration

Six Blue Book standards – monitored by NHFD 1.All patients with hip fracture should be admitted to an acute orthopaedic ward within 4 hours of presentation 2.All patients with hip fracture if medically fit should have surgery within 48 hours of admission, during normal working hours 3.All patients with hip fracture should be assessed and cared for to minimise risk of a pressure ulcer 4.All patients presenting with a fragility fracture should be managed on an orthopaedic ward with routine access to orthogeriatric medical support from admission 5.All fragility fracture patients should be assessed for need of antiresorptive therapy to prevent future osteoporotic fractures 6.All fragility fracture patients should be offered multidisciplinary assessment and intervention to prevent future falls

UK NHFD Reports: Individual reports for 26 hospitals Analysis on 12,983 records from 64 hospitals Analysis on 36,556 records from 129 hospitals Analysis on 53,443 records from 176 hospitals ALL eligible hospitals registered 191/191

2011 National Hip Fracture Database Report Key metrics NHFD 2011 National Report. Available from Surgery within 36 hoursPre-op medical assessmentAcute Length of Stay

Three-year trend data: 30,022 patients from 28 hospitals Binomial test p-value <0.001 for all trends; average mortality at 30 days fell from 9.4% to 8%.

Registry National Guidelines Quality Indicators Policy Models of Care Safety & Quality System Redesign Training / Education Resourcing models of care Local training / support Consumer Manifesto Implementing best practice Measuring performance National Steering Group States and Territories LHDsHospitals

National Hip Fracture Database Employs 4 people and now funded by DOH Now has got 189 of 191 hospitals sending data (England, Wales, Northern Ireland) Annual reporting since 2008 –2008: ? patients from 26 hospitals –2009: 12,983 patients from 64 hospitals –2010: 36,556 patients from 129 hospitals –2011: 56,000 patients from 176 hospitals 82% of predicted hip fractures

National Hip Fracture Database Total hip fracture records = 137,933 –Reports process indicators and case-mix adjusted outcomes (e.g. 30 day mortality) –All hospitals identified in reports

Best Practice Tariff

Aims –To reduce unexplained variation in quality –To universalise best practice Key indicators –Surgery within 36 hours –Involvement of Geriatricians Balanced Scorecard for Hip Fractures

BPT - Payment All criteria must be met Tariff –Reduced previous average payment by 10% –If criteria met – get old payment + extra –Extra = £445 If doing 300 / yr = £134,000 = $270,000 per yr From 2011: £890 = £267,000 = $530,000 per yr Enough to allow investment in change, improvement and data collection

How System Works Local Hospital National Hip Fracture Database Commissioners Pay additional funds quarterly Provide NHI and individual patient data Notify BPT compliance Importance of “trust” in each segment of system

So why have a registry? Improve patient outcomes –Death, dependency and institutionalisation Safety and quality –e.g. timely and appropriate interventions Reduce inequalities –Local organisational, rural remote Driver for organisational change Use the data to shape practice Undertake additional research

Australia and New Zealand Hip Fracture Database Inaugural Meeting October 2011 Working Group Established Strong support from HQSC – NZ & Aust Professional Societies OA NZ & Aust

Progress with a National Registry Auditing at facility level – NSW, NZ, WA Piloting at patient level in NSW WA/CMDHB have started electronic database Guidelines and quality indicators to be completed in 2012 Consumer manifesto – 2012 Conversations re build and operation of a national database

Progress NZ Workshop planned May 2012 led by HQSC, NZ with NZ stakeholders participating (ACC, MOH, NHB, IT board, CNBU)

Discussion Thank you